Increased sundowning, will this settle down?

How to cope:

As JTFW1924 suggested, you have to "go with the flow."

Learn all you can about sun-downing, redirecting focus, how to deal with various behaviors, etc. Sometimes simple adjustments such as lighting can help. Be agreeable to anything she says/does (so long as there's no safety concerns.) Don't argue with or try to correct her. You will only frustrate yourselves and her more, and ramp up her anger/anxiety. Fibbing to assuage her will come in handy (use it to defer going home, perhaps tomorrow, make plausible excuses for missing child, such as having a sleep over with friend, etc.) Try to get her focus onto something else, cup of tea, snack, some activity, etc. Since it appears to be afternoon, DO consider an anti-anxiety medication. The lowest dose should be enough to take the "edge" off and won't "dope" her up. For our mother, it didn't take time to build up in her system (worked first time, every time) and there's no withdrawal issue if/when it isn't used anymore.

For the talking/repetition, just be agreeable, go along with whatever (exception is the child/fear - find an excuse why the child isn't there.) Response to questions should be kept as simple as possible - no details. Why am I here? Just for a visit, dinner, to help with something, whatever might work. When can I go home? Soon, a little later, tomorrow, or whatever works. No long detailed explanations, no long winded responses. No reminding her she agreed to the move(s) - she doesn't remember it and you won't get her to acknowledge that now!

I do understand how the constant barrage gets under your skin. I didn't live with mom, but a 30 minute phone call that was a repetition of the same 3 things over and over... augh! Just yesterday I stopped by. She kept saying she'd like these shoes in the sale flyer, over and over, and they're only $29! I show her similar ones at WM on my phone, only $10. Annnnd repeat... Once they get fixated on something, it can just go on and on. You have to get informed and skilled at changing the subject, changing her focus. I liken it to a scratch on a record, which keeps skipping and playing the same thing over and over. A little nudge and it moves on (sometimes to the next scratch, but at least it is different and can be nudged again!)

Although I already posted it, I can't stress enough that you should get a urine test/culture. IF it turns out she has a UTI and it gets treated, all the above will just be learning how to deal with it in the future - the current should go back to near "normal" (from before the fall.)

Your profile indicates your mother has dementia. She may have only been in the early stages so this odd behavior seems new. There are several medical conditions that can contribute to what seems to be a jump in progression. UTI is the easiest to check for and is highly suspect based on your comment "There has been some late in the day confusion but not to this extent." (see below.) However, it just may be coincidence that the fall and the move into another stage of dementia happened around the same time.

*Doesn't sound like her injuries required any anesthesia, but perhaps they did include some kind of IV pain meds in hospital - those can take time to clear from the system.

*Being in unfamiliar places can disorient people who have dementia. Not so much your family places, but the hospital. Moving to AL is likely to contribute to this continuing, so beware.

*UTI - you say "...no pain on urination, no fever, says no pain." UTIs affect those with dementia very oddly (sometimes even w/out dementia, just being elderly.) Our mother used to get UTIs a lot before the dementia, but would have the usual symptoms. Her first UTI at MC, quite a while after moving there, presented as sun-downing, BIG time. She had NO signs of sun-downing before the UTI and none since. There wasn't any sign of pain, no other reason to suspect UTI. At that time she also insisted she had to get out, go home, had guests coming, etc. In the mornings she would be fine. Next afternoon, watch out! We had to treat the UTI and use anti-anxiety 1/day to prevent/lessen the sun-downing. After UTI treated, she was fine, no more medication needed. The next 2 UTIs presented as night-time bed wetting only. So, it's easy enough to test for, but I recommend a urine culture, as sometimes the dip test doesn't catch it!

As for other comments:

"But she has never acknowledged that she cant live by herself, thinks she us going to get better and go home" Typical. Mom didn't have an "issue", didn't want to move and pestered YB for a long time to take her home.

"She has even confused her grandson with her husband..." Looking at a pic of herself with me and my daughter, she asked who those "girls" were and if that was Nana (her mother, but pointing to the pic of herself.) Their mind slowly progresses back in time, so her grandson may resemble her husband when he was younger.

"She's asked that she call her Mom(dead 34 years)" After 9 months living in MC, out of the blue she asked me to drop her off at Nana's place on my way home. Her mother is gone 40+ years! I suggested tomorrow, then it was about a previous home. She asks about her, have we seen her, what's she doing for X holiday and asks staff to call her.

"Looking for her 4 year old child." While visiting I found mom had little lolly pops. When asked why, she said they were for her kids, if they ever show up. I pointed to myself and she asked if my kids were there. So, apparently I live in two planes of existence!

"Says that she is scared, but cant tell me why." Often they can't express what it is that is scaring them - it might just be some inkling of understanding something is wrong, but no clue what it is.

"Im afraid she is speeding past Aliving into Memory Care. But during her lucid daytime, she would be horrified to be there." Unless it can be determined what is causing the increase in confusion and regression, more than likely she will have to be in MC. Sometimes it's recommended to make the move to MC, as additional changes, i.e. moving, leads to more confusion. In mom's facility, the only real difference between AL and MC is the MC is locked down. She is most likely going to take the move hard whichever place you choose.

"...move some of her furniture to the Assisted Living apartment, since its been paid for..."  If the facility has MC too, I would ask if the payment could be used for that, if she needs it now. Better to discuss with them, but hiring someone may help (she may need 24 hour care.)

Thank you to everyone who responded. I'm hoping this is not her new normal, since her confusion about what's going on is so upsetting to her. It's hard to see your Mom cry and keep saying she wants to call her family. But the people she wants to call are all dead.

Melatonin could help her calm down in the evenings.

Gracie: Good that you are getting her checked out at her neurologist.

While you are getting her checked out, I will wholeheartedly second what gdaughter said. When my mom was in the hospital I had never even heard of sundowning.
She would get very irrational & agitated - not like her usual self at all.
She thought she was back in her real estate days and kept grilling me if I had "put out the fliers."
Not knowing what sundowning was, I tried to reason with her. This only served to agitate her further.
My brother said to try agreeing w/ her. I did, and it was night & day. It will be to her & your advantage to just go w/ the flow. Agree, do / say whatever to put her mind at ease.

I thought this state of affairs was just how things were going to permanently be from here on out. Only after I talked to the nurse did she casually remark, "Oh she's just sundowning." Then she had to explain to me what that was. Said it was super common in the geriatric ward; unfamiliar environments can contribute. Is your mom at her usual home or staying elsewhere now?

My mom is back home now and has no recollection of those sundowning episodes.

Is she on a new med, eg Trazadone for sleep. It causes confusion and visual hallucinations in elderly . Happened to my neighbor. Confusing clear quickly ( within a day or so) once he stopped taking Trazadone. Replaced it with calcium/magnesium tablet taken with small glass of milk 20 mins. before bed. Tablets that contain both calcium 1,000 mgs. and Magnesium 500 mgs. are available on-line or at Whole Foods.

As to the Sundowner's, here's an idea that came to me, just an idea.
There are special lamps used to treat Seasonal Affective Disorder, that provide simulated "daylight" . Maybe it would work to get on of those lamps and turn it on as the afternoon turns to evening, with hopes that it would provide the effect of daylight as sundown approaches, thus sort of tricking her brain into thinking it's still daytime.
Don't remember if you said she had UTI, but garlic is a natural anti biotic and prevents and treats UTIs.

Does she get more lucid (more her regular self) during the day? Was she prescribed pain meds other than over the counter NSAIDs? IS she getting less sleep than usual? If any are yes, than we have our answers - narcotics can cause some confusion, less sleep can cause more confusion, more pain can cause her to be more agitated. If she is more like her usual self for some part of the day... this will pass once her injuries heal. She may have a slight concussion (brain bruise) that should resolve on it's own.

Does she remain confused throughout the day? Is she on any blood thinners or medications that tend to thin the blood? Have you noticed weakness on a side of the body or mouth (ask her to smile and stick out her tongue)? Are symptoms worsening? Headache, especially with light sensitivity or nausea/vomiting? If yes, then you want to follow up sooner with a doctor. She could develop a brain bleed (stroke) from a slowly leaking area. These may require more treatments than a wait and see approach.

Realize it takes older bodies longer to heal than younger ones. If she was on medications that thin the blood, she will have more bruising and swelling than other folks,,, which will take a little longer to heal.

Beyond the other reasonable advice here, just in case this might be helpful, when she is bringing up things that make no sense or gives you the "I want to go home" or I have to go home lines, rather than being truthful or rational or argumentative with the reality, remember you have permission to lie. A sitter is with the child; ok, we'll get you home in the morning...(by which time she likely forgets). On my parents last trip to FL to see my sister, we didn't realize mom was getting on the path already...she was quite distressed to learn they'd be there 10 days...oh no, she had bills to pay...my sister repeatedly showed her the calendar. THEN she just happened to tell her she was going home "the day after tomorrow". It did the trick. It was soon enough to satisfy her and then she'd forget or couldn't process the concept...It was my last staycation.

I agree with the others that she needs a recheck - ERs generally stabilize, but expect further treatment to be elsewhere. Although they said recheck in 2 weeks, that was given she was stable at the time of discharge! Neurologist is probably better for this recheck than any regular doc. Stress to them when calling to schedule that she's had severe issues since discharge, to highlight the need to get her in sooner rather than later!

It can't hurt to recheck for UTI. Sometimes it requires a culture test, not just the dip stick test. Our mother had some odd OCD behavior which started just before she went to bed (was living alone and we had some cameras in place) and became a nightly marathon (1-1.5 hours of checking the door lock, side lights, dishwasher and LR.) This was most likely her "version" of sun-downing. She really didn't exhibit any issues like this after the move to MC, until she had her first UTI there. THEN she was out of control late every afternoon/early evening. Fine the next morning.

When I first joined this site (before the move and UTI) I was skeptical of the UTI comments, until this happened! In addition to the antibiotics, she was given Lorazepam (anti-anxiety) in the afternoon, minimal dose. It was just enough to take the "edge" off, and was only used during the UTI treatment (in your case she might need it every day, if she was already sun-downing and non-medical interventions don't work.) After mom's UTI, we kept it on hand "as needed" only, mainly because her "trip" happened on a Friday night and we had to wait until Monday to get this checked! For the most part we haven't needed it since.

Although I prefer not to medicate, this medication was great as it doesn't take time to build up and can be discontinued when not needed (worked first time/every time we needed it and no withdrawals.) Not all medications work for everyone, so it could take trying others. Since this did work quickly for our mother, it shouldn't take more than a dose or 2 to determine if it works for your mother - then something else could be tried if it doesn't work. Two subsequent UTIs our mother had presented as night-time bed wetting, big time!

As for stairs, best to avoid them if possible. In a situation like your daughter's, it might help to have some bright colored tape on that last step, to make it more obvious. It is easy to miss steps, even when not older or impaired with dementia!

You have been given some good medical advice here, which I am sure you will follow up. The slow brain bleed is worth careful investigation. On a practical level, here are a few suggestions:
1. To prevent falls when with someone with dementia, it is good practice not to talk to them while they are on the stairs. That way that will focus more on the stairs and not on the conversation. However, some people with dementia could find it helpful to hear your encouragement while they are negotiating the stairs, so there is no single answer here. Staying close enough to prevent a fall (if that is possible) is also a good approach.
2. Avoiding stairs if at all possible is a good idea. This might mean turning a downstairs room into a bedroom, but the inconvenience is much easier to handle than a serious fall. You can get a chair lift, but they are expensive and their resale value is very low. Some people also will not use them. I would check carefully if the person with dementia is safe to sit in it and is willing to use it. I would be doubtful on both counts if this is a solution.
3. You are probably right that the lack of carpet on the bottom stair was the cause of the fall. Check carefully on carpet locations and colors to see if any changes need to be made.
4. "Sundowning" is a challenge and needs to be considered in planning the daily routine. There is some evidence that getting enough sleep helps those with dementia to deal with the plaques and tangles in the brain. Sleep doesn't remove them, but it does seem to help the person with dementia recover from their effects. Try to see what pattern of sleep and activity works best. If the person with dementia is getting very confused in the late afternoon, see if different bedtimes or naps in either the morning or afternoon are helpful.
5. Check carefully that the person with dementia is getting enough liquids in order to avoid dehydration.

Prayers and the hope of helpful remedies in a challenging situation

If you haven't done so already, please get your mom medical attention immediately. The same thing happened to my father-in-law, though he had not been diagnosed with Alzheimer's at the time. He'd had several falls, but didn't think anything of them until he suddenly had odd spells of being unable to speak or walk, and a spontaneous lack of bladder control, at which point my husband flew out to see him and got him to the ER. He was hospitalized and declined rapidly. It turned out to be a subdural hematoma, which was surgically repaired, and the surgeon advised that the bleeding was from a very old injury that had most likely occurred several weeks prior to the onset of symptoms.

I’d support the suggestion that the fall may have caused a slow brain bleed that didn’t show up immediately. My mother in her 60s had a fall, hospital checked and sent home, drove two days to see my sister, and three weeks later had to be brought back by the Flying Doctor. Bi-lateral sub-dural haematoma. Worth a check!

A neurological evaluation would be indicated. When she fell, she sustained a head injury (broken cheekbone, bruises.) A CT scan at the time of the ER evaluation may not have showed anything significant. However, you mention a change in behavior since this incident with worsening "sundowning." It may be that there is something going on in the brain such as a slow brain bleed. That may not have been present in the ER but may be present now. The neurologist is expert in evaluating such issues. He may order repeat testing and further treatment.

Unfortunately, given her current sundowning behavior, she may be beyond AL and need Memory Care. Sundowning symptoms are very difficult to manage, and as a daughter whose mother in memory care suffers from that, I leave it to the staff to handle since they are arms length and are trained/used to dealing with that. We do not take mom out or visit later in the afternoon, it's just not good for her.

I would get her seen by a doctor that is not a hospitalist.

I have had no good luck with them and it is truly no wonder that medical errors are the 3rd leading cause of death in the USA.

Something has obviously happened for all of this sudden mental decline. She could even have a UTI, or it could be something else, but it should be checked into.

I am so sorry that your mom fell. That is enough to shake anyone to the core. Hugs to both of you.

Is she "fine" during the day, or is she agitated then as well?

One of my mother's doctors instructed me "a change in mental status is a medical event and needs to be reported to the doctor right away".

I wonder if perhaps the fall was precipitated by a TIA or stroke? Sometimes they dont show up in the ER.

I would call mom's doc right away and ask for her to be seen today. 2 weeks is too long to wait.